Provider Demographics
NPI:1255338091
Name:TOWN OF WINDHAM
Entity type:Organization
Organization Name:TOWN OF WINDHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-465-3060
Mailing Address - Street 1:269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2302
Mailing Address - Country:US
Mailing Address - Phone:860-638-1800
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:13 BANK ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2441
Practice Address - Country:US
Practice Address - Phone:860-465-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
004010583OtherPREFFERED ONE
CT710L163A2CT01OtherBLUE CROSS
004010583OtherCOMMUNITY HEALTH NETWORK
CT00401058300OtherBLUE CARE FAMILY PLAN
CT004010583Medicaid
004010583OtherPREFFERED ONE
CT590012538Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CT00401058300OtherBLUE CARE FAMILY PLAN